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rheumatology > rheumatoid arthritis & treatment > Flashcards

rheumatoid arthritis & treatment Flashcards

1
Q
  • chronic autoimmune inflammatory disease where the synovial tissue is inflamed and locally destructive with increased mortality and morbidity
  • can also affect skin, eyes, heart, lungs, nerves
  • often remission during pregnancy
A

rheumatoid arthritis

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2
Q

list 3 pathogenic factors for RA

A
  • hormones– more common in women
  • cigaretes
  • infections- oral bacteria, viruses, microbiome
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3
Q

common digital manifestations of RA (4)

A
  • Swan neck deformity of the hand
  • Boutonnier’s deformities & nodules
  • MCP erosions
  • Ulnar deviation/subluxation
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4
Q

6 common extra-articular manifestations of RA

A
  • scleritis
  • corneal perforation
  • vasculitis
  • ILD- honey combing;
  • pericarditis/pleuritis
  • synovitis
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5
Q
  • autoantibody against the Fc portion of IgG; high titer associated w/ severe dz, erosions, nodules, extraarticular manifestations
  • not specific for RA– Sjogren syndrome, infections, healthy individuals
  • higher titers equals more severe disease
A

rheumatoid factor

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6
Q

possibly pathogenic antibody; sometimes in TB, ILD, smokers and relatives of patients with RA
* associated w/ earlier joint damage

A

anti CCP

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7
Q

which hand joints are affected with RA?

A

MCP, intercarpals
IP joints are spared!!

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8
Q

often suddent onset at any age; commonly has systemic symptoms; joint exam shows swelling and deformities
+++ joint effusions and synovial thickening
erosions on xray

A

RA

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9
Q

3 joints that RA rarely affects

A

DIP/IP joints
T/L spine
hip

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10
Q

indirect measure of inflammation affected by RBCs, fibrinogen and immunoglobulins; correlates with joint damage/erosions

A

ESR

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11
Q

lab test NOT dependent on RBC #, made in liver & also correlates with joint damage/erosions

A

CRP

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12
Q

what test may correlate with disease activity

A

CCP antibodies (NOT RF)

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13
Q

4 main causes of mortality with RA

A
  • coronary artery disease
  • non-hodgkin’s lymphoma
  • ILD
  • medication ADR– bleeding, infections
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14
Q

SE includes gastritis, ulcers, reduced GFR, edema, kidney failure, MI, HTN, HA, etc
interacts with warfarin

A

NSAIDs

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15
Q

what class? 2 meds within the class

used as temp. tx until other meds take effect; use lowest dose for shortest time; IM injections stop a flare;immunosuppressive

A

steroids– prednisone 10-30mg & triamcinolong acetonide 40-120 mg IM

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16
Q

what medication? what must be monitored? what must be done before start?

  • blocks dihydrofolate reductase, purine & pyrimidine; increases extracellular adenosine
  • ADR: transaminase elevation, fatigue, nausea, diarrhea, cytopenias, HA, acute interstitial pneumonia
  • 6 months to full effect
  • decreases B,T & monocyte cell activity
A
  • Methotrexate
  • monitor CBC, transaminase & creatinine Q 3 months
  • must do TB screening & pregnant test before starting
17
Q

first line tx for mod/severe RA if not pregnant? if pregnant?

A
  • Methotrexate
  • Sulfasalazine or Hydroxychloroquine if pregnant
18
Q

what med? what must you do prior to staring this med?

  • immunomodulator that blocks Toll Like Receptors (TLR) w/ 6 months to action
  • ADR– retinopathy related to cumulative dose, GI issues, myopathyrash, HA, depression
A

hydroxychloroquine
- must do visual exam and yearly after 5th yr

19
Q
  • immunomodulating drug that inhibits IL-2 induced T cell proliferation, changes B lymphocyte function & reduces cytokines
  • ADR: nausea, SJS, bone marrow issues, HA
A

sulfasalazine
not for sulfa allergies

20
Q

what 3 meds are used in triple therapy treatment?

A

sulfasalazine
hydroxychloroquine
methotrexate

21
Q

what class? what should be screened before starting>

SE: infections, chills & HA (infusions), rash (injections)
CI: COPD, CHF

A

anti-TNF inhibitors
- infliximab (infusion), adalimumab, etanercept
- screen for TB, hep B & C

22
Q

what class?

  • blocks intracellular pathways following membrane activation
  • SE: infections, abnormal LFTs, neutropenia, elevated lipids or creatitne, DVT, MI?, cancer
A

JAK inhibitors– tofacitinib, baricitinib, upadacitinib

23
Q
  • blocks costimulatory signal for T cell activation
  • used alone or with methotrexate or other DMARDs
  • infused monthly; injected 125mg weekly
  • SE: rare infusion rxns, infections
A

T-cell activation inhibitor (abatacept)

24
Q
  • used in active RA as 2nd or 3rd line tx
  • ADR: elevated liver tests, hyperlipidemia, increased infection risk
A

IL-6 inhibition– tocilizumab & sarilumab

25
Q

how does treatment affect disease progress?

A

can achieve full remission & improve survival

26
Q

4 main components of the points based diagnosis for RA? how many points needed?

A
  • inflammatory arthritis in 3+ joints
    • RF or anti-CCP
  • elevated CRP or ESR
  • duration over 6 weeks

need at least 6

rheumatology (10 decks)

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